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John D. Loeser, MD, Department Editor
Reviewed by Stuart Farber, MD
E. Bruera & R. Portenoy, Oxford University Press, New York, 1998, 320 pages, $46.95 (hardcover), ISBN 0-19-510246-0
Lewis Thomas wrote the following in The Youngest Scientist (1983):
I had been asked to come to the annual meeting of a country medical society in the center of Mississippi, to deliver an address on antibiotics. The meeting was at the local hotel, and my host was the newly elected president of the society, a general practitioner in his forties, a successful physician whose career was to be capped that evening, after the banquet, by his inauguration; to be the president of the county medical society was a major honor in that part of the world. During the dinner he was called to the telephone and came back to the head table a few minutes later to apologize; he had an emergency call to make. The dinner progressed, the ceremony for his induction as president was conducted awkwardly in his absence, I made my speech, the evening ended, and just as the people were going out the door he reappeared looking harassed and tired. I asked him what the call had been. It was an old woman, he said, a patient he'd looked after for years; early that evening she had died, that was the telephone call. He knew the family was in distress and needed him, so he had to go. He was sorry to have missed the evening, he had looked forward to it all year, but some things can't be helped, he said. This was in the early 1950s, when medicine was turning into a science, but the old art was still in place.
—Lewis
Lewis Thomas' insights seem to be a perfect way to introduce this second volume in a series devoted to topics in palliative care. The topics covered include pain (neuropathic), cachexia/anorexia, asthenia, and psychological issues in the caregiver (both family and professional).
These are subjects to which Lewis Thomas was introduced by his physician father long before medicine became a science. All of them are still an intimate part of the experience of patients, families, and healthcare providers in dealing with advanced illness and end-of-life care. What do we know about these "diseases"? What should we be asking? What are the best clinical treatments now available for each of them? Leaders in the field of palliative medicine answer these questions thoughtfully and in depth. Each topic is briefly introduced by the editors or by a leader in the field, who asks important questions about its relevance to academic and practicing physicians. The introduction is followed by an in-depth review of the scientific literature and a discussion of our present understanding, as well as questions that need further investigation. The topic discussion concludes with a clinical review of current treatments and their effectiveness.
I recommend this book highly to both practicing clinicians and academic researchers. It raises the central topics in palliative medicine to the highest level of science by building upon their origin in the art of medicine.
Stuart Farber is clinical assistant professor of family medicine at the University of Washington School of Medicine in Seattle.
Reviewer content represents the opinion of the reviewer, not APS.
Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor, at jdloeser@u.washington.edu
